Management of sleep problems in Parkinson's disease.

Patients with Parkinson's disease (PD) frequently complain of sleep problems. These can be due to several factors, and the approach to their management depends on careful consideration of the various possible factors in each case. 1. Older people, in general, require less sleep. After retirement, people may also engage in less physical activity, and this factor is of course even more pronounced in patients with PD because of their illness. 2. Daytime naps, either spontaneous or due to drugs, reduce the need for nocturnal sleep. Explanation of these physiological and circumstantial changes may help those PD patients who manifest these consequences. 3. The existence of a severe progressive disease as well as social isolation have psychologic consequences, such as anxiety and depression, that may manifest as insomnia. Furthermore, depression is part of the disease, frequently antedating the motor manifestations, and may manifest as insomnia. 4. In advanced disease, patients may be immobile and have difficulty in getting up or even turning in bed. This causes great inconvenience, and may impair sleep. Long acting anti-Parkinson drugs such as cabergoline or rotigotine patch may help. 5. In some cases, unpleasant hallucinations may appear which prevent the patient from falling asleep. These may respond to atypical neuroleptics. Clozapine and quetiapine are particularly useful, but require attention to possible adverse effects.